Group Size Matters
Group size is an important factor in determining several aspects of health insurance coverage.
ATNE Platform Rating — In January 2021, the Arkansas Insurance Department sent out a bulletin stating that the ATNE should be used to determine group rating size.
- Groups with an ATNE of 51+ will be rated on the large group platform.
- Groups with an ATNE of 50 or less will be rated on the small group platform.
Consolidated Omnibus Budget Reconciliation Act (COBRA) — COBRA generally applies to all group health plans maintained either by private-sector employers with at least 20 employees or by state and local governments. It does not apply to plans sponsored by the Federal Government or by churches and certain church-related organizations. Many states also have laws similar to COBRA, including those that apply to health insurers of employers with less than 20 employees (sometimes called mini-COBRA). Check with your state insurance commissioner’s office to see if such coverage is available to you.
Medicare Secondary Payer Regulations (MSP) — When coordinating benefits with Medicare, the beneficiary’s entitlement, along with the group’s number of employees, determines the position of the primary payer. For example:
- If you’re 65 or older, have group health plan coverage based on your or your spouse’s current employment, and the employer has 20 or more employees, your group health plan pays first.
- If you’re 65 or older, have group health plan coverage based on your or your spouse’s current employment, and the employer has fewer than 20 employees, Medicare pays first.
To learn more about how other insurance (e.g. group health plans, retiree health, or Medicaid coverage) works with Medicare, download the 2024 Medicare and You (PDF) handbook. A chart outlining rules determining the primary payer can be found on page 21.
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